Gas gangrene of the liver after a choledocho-jejunostomy.

C-reactive protein of 253 mg/l. Liver tests showed an alkaline phosphatase of 270 IU/l, alanine aminotransferase of 707 IU/l, aspartate aminotransferase of 1,912 IU/l, total bilirubin of 59 mol/l, lactate dehydrogenase of 4,678 IU/l and  -glutamyl-transpeptidase of 94 IU/l. A CT scan revealed partial necrosis of the liver, especially the left liver lobe, with extensive air in the bile ducts and the parenchyma concordant to gas gangrene ( fig. 1 , 2 ). Several hours later the patient died. At autopsy, the A 57-year-old female was referred to our surgical department because of a carcinoma in the head of the pancreas. We performed a laparotomy and found a metastasis next to the hepatic artery and therefore a choledochojejunostomy and a gastro-enterostomy were created. The patient recovered rapidly. Unexpectedly, the day before the planned discharge, she developed abdominal pain in the right upper quadrant with fever up to 39 ° C. Laboratory studies showed a white cell count of 47,700/mm 3 and Published online: July 15, 2008